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Published on: December 6, 2016
Adenotonsillectomy Versus Watchful Waiting for Children with Obstructive Sleep Apnea Syndrome: A Systematic Review
Alexios Tsikopoulos1, Konstantinos Tsikopoulos2, Fotios Dilmperis3
11st Department of Otorhinolaryngology-Head and Neck Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Kiriakidi 1, Thessaloniki, 546 21 Greece.
Insights
Adenotonsillectomy (ATE) significantly improves the apnea-hypopnea index (AHI) and quality of life in children with Obstructive Sleep Apnea Syndrome (OSAS) compared to watchful waiting. This benefit is observed even in mild and moderate OSAS cases.
Area of Science:
- Otorhinolaryngology
- Pediatric Sleep Medicine
- Evidence-Based Medicine
Background:
- Obstructive Sleep Apnea Syndrome (OSAS) in children presents treatment challenges.
- Adenotonsillectomy (ATE) and watchful waiting are debated management strategies.
- Comparative efficacy data for these approaches are crucial for clinical decision-making.
Purpose of the Study:
- To compare the clinical outcomes of adenotonsillectomy (ATE) versus watchful waiting in pediatric OSAS.
- To evaluate the impact on apnea-hypopnea index (AHI), quality of life (OSA-18), and oxygen saturation (SpO2).
- To conduct subgroup analyses based on OSAS severity.
Main Methods:
- Systematic literature search of PubMed, Scopus, and CENTRAL databases up to October 2023.
- Inclusion of comparative trials (randomized and non-randomized) assessing ATE vs. watchful waiting.
- Random-effects pairwise meta-analysis of change scores for AHI, OSA-18, and SpO2.
Main Results:
- ATE demonstrated a statistically significant reduction in AHI compared to watchful waiting (SMD -0.60).
- Quality of life, measured by OSA-18, significantly improved with ATE (SMD -0.79).
- No significant difference in SpO2 levels was found between the groups. Subgroup analyses showed ATE superiority for mild and mild-to-moderate OSAS.
Conclusions:
- Adenotonsillectomy is superior to watchful waiting for improving AHI and quality of life in children with OSAS.
- The benefits of ATE are evident even in cases of mild and mild-to-moderate OSAS.
- Evidence of moderate strength supports ATE as an effective treatment option for pediatric OSAS.
Abstract:
The treatment of children with Obstructive Sleep Apnea Syndrome (OSAS) remains a point of debate among otorhinolaryngologists worldwide. This study aims to comparatively assess the clinical outcomes of adenotonsillectomy (ATE) and watchful waiting in children with OSAS. We searched the databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), until the 1st of October 2023. Comparative trials assessing the efficacy of adenotonsillectomy and watchful waiting in children with OSAS were considered. The primary outcome measure was the apnea-hypopnea index (AHI), and secondary outcomes included quality of life as measured by OSA-18 score, and mean SpO2 levels. A subgroup analysis evaluating the changes in AHI depending on the severity of the initial disease was also executed. We conducted a random-effects pairwise meta-analysis of change scores to include randomized and non-randomized controlled trials. The quality assessment was carried out by using the Cochrane risk of bias tool for randomized and the ROBINS-I tool for non-randomized trials, respectively. Two randomized and five non-randomized trials were included. There was a statistically significant difference regarding AHI in favor of the ATE group compared to the watchful waiting group (Standardized mean difference [SMD] was - 0.60, 95%CI -0.79 to -0.41, p < 0.001). Likewise, a statistically significant decrease in change scores for OSA-18 between ATE and watchful waiting was noted (SMD was - 0.79, 95%CI -0.97 to -0.61, p < 0.001). On the other hand, there was no significant difference when ATE and watchful waiting groups were compared for SpO2 levels between each other (SMD was 0.52, 95%CI -1.53 to 2.56, p < 0.62). In the subgroup analysis assessing mild OSAS, there was a significant difference in favor of ATE compared to watchful waiting (SMD was -0.91, 95%CI -1.35 to -0.47, p < 0.0001). For mild to moderate OSAS, similar results were noted favoring ATE as well (SMD was - 0.53, 95%CI -0.87 to -0.19, p < 0.003). This study provides evidence of moderate strength supporting the superiority of ATE over the watchful waiting approach in terms of AHI and OSA-18. This also appears to be the case for AHI in children with mild and mild to moderate OSAS.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s12070-024-04738-0.
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